What happens when those we trust most with human life are suddenly in charge of death?
Earlier this month, the B.C. Court of Appeal upheld a decision by the Supreme Court of Canada, ruling against a family who wanted their mother’s care home to stop spoon-feeding her.
It’s difficult to fault either party.
Margaret Bentley, 83, neither speaks nor recognizes her relatives, and her family is certain the former dementia-ward nurse, now in the late stages of Alzheimer’s disease herself, would not want her life to continue in her current state.
A living will written by Bentley in 1991 outlined as much in no uncertain terms: “If at such a time the situation should arise that there is no reasonable expectation of my recovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by artificial means or ‘heroic measures.’ ”
But Bentley’s health-care workers refused to deliberately withhold food. They argued that by opening her lips to receive food when touched with a spoon, Bentley was consenting to being fed, and thus to being kept alive. The courts agreed. . . [Full text]
In a 44 page judgement, Mr. Justice Greyell of the Supreme Court of British Columbia has ruled that family members cannot order caregivers at a nursing home to starve an 83 year old resident to death. Margot Bentley, age 83, is in the final stages of Alzheimer’s disease. Based on written instructions she left before being diagnosed with the disease, family members went to court to stop caregivers from spoonfeeding her when she opened her mouth to accept food. The judge noted that she is not dying, and that to comply with their wishes wold mean that Mrs. Bentley would die from starvation and dehydration and not an underlying disease.
Having considered the evidence, he rejected the claim that Mrs. Bentley is in a “vegetative state” as “neither useful nor accurate,” concluding, instead, that it was possible that she had sufficient mental function to decide whether or not to eat and drink and to communicate that decision in non-verbal ways. He held that spoon-feeding was not “health care” within the meaning of the law, but a form of personal care. While he agreed that, under the common law, a competent adult can refuse food and fluids and thus commit suicide, he ruled that there was no legal precedent for the finding that such a decision could be made on behalf of an incompetent person by a proxy decision maker. On the other hand he recognized statutory and public policy considerations that would tell against such a finding.
The case is of interest because it demonstrates how the kind of directives the family pursued in this case can generate conflicts of conscience among caregivers and health care workers.
82 year old Margot Bentley is living in a nursing home in Abbotsford, British Columbia, Canada, administered by the Maplewood Seniors Care Society, Fraser Health Authority and the government of British Columbia. She has Alzheimer’s disease and is being spoon-fed because she can still swallow. She is not force-fed if she does not open her mouth. Her family has launched a civil suit to compel the nursing home to stop feeding her, citing her “living will” signed in 1991, about ten years before she was diagnosed with Alzheimer’s. The document states that she did not want “nourishment or liquids” if she is suffering from an incurable disease. The defendant nursing home has filed another “living will” that states that she would accept “basic care.” The authenticity of the document is disputed by the family. The nursing home argues that spoon-feeding is basic care, not “medical” care or treatment, and is legally obligatory. The family insists that spoon-feeding must be discontinued, since patients are entitled to refuse medical treatment or care, and Margot Bentley had stated that refusal in her “living will.” [Vancouver Sun]